[The use of a simple algorithm to improve proteinuria diagnosis in clinical laboratories]. / Implantación en el laboratorio de un algoritmo para el diagnóstico diferencial de la proteinuria.

BACKGROUND AND OBJECTIVE: When proteinuria appears, a differential diagnosis must determine its origin. The object of this work has been to evaluate the results after the laboratory implantation of an algorithm for the screening and diagnosis of proteinuria. MATERIAL AND METHODS: From a total of 30,718 processed urines, a 30 mg/dl or higher protein concentration was obtained in 639, recommending a new sample to confirm and differentiate proteinuria. We received 207, to which total protein, creatinine, albumin and alpha-1-microglobulin were quantified, together with pseudoperoxidase and leukocyte esterase from dipstick. The results were introduced in an expert system (UPES and its application Protis), allowing differentiate hematuria, leukocyturia and proteinuria and suggesting the assessment of other parameters, like IgG, alpha-2-macroglobulin, light chain kappa/lambda, when necessary. RESULTS: From 207 urinalysis assayed for selective proteinuria, 39 were normal, 96 were classified as primary glomerulopathy, 26 as secondary glomerulopathy and 5 as tubulo-interstitial nephropathy. A differential diagnosis of hematuria was made in 58 of these urines. Besides, kappa light chains were detected in a sample from a patient with a normal serum protein graph, which were confirmed by immune fixation. CONCLUSION: With the proposed algorithm, the information obtained from a urine sample increases substantially, allowing detection and differentiation of proteinuria and providing suggestions for the clinical evaluation of the patient.

Implantación en el laboratorio de un algoritmo para el diagnóstico diferencial de la proteinuria / The use of a simple algorithm to improve proteinuria diagnosis in clinical laboratories

Fundamento y objetivo: El hallazgo de proteinuria debe ir seguido de un diagnóstico diferencial para determinar su origen. Nuestro objetivo ha sido valorar los resultados de la implantación por el laboratorio de un algoritmo para el cribado y diagnóstico de la proteinuria. Material y métodos: De un total de 30.718 orinas procesadas, se obtuvo una concentración de proteínas igual o superior a 30 mg/dl en 639, recomendándose el envío de una nueva muestra para confirmación y estudio diferencial de proteinuria. Se recibieron 207, a las que, además de las proteínas totales, se les cuantificaron creatinina, albúmina y alfa-1-microglobulina, junto con los parámetros de la tira reactiva pseudoperoxidasa y esterasa leucocitaria. Estos resultados se incorporaron a un sistema experto (UPES y su aplicación Protis), que permite la diferenciación de hematuria, leucocituria y proteinuria, solicitando la medida de otras pruebas (IgG, alfa-2-macroglobulina, cadenas ligeras kappa/lambda) cuando es necesario. Resultados: De las 207 peticiones recibidas para estudio de proteinuria selectiva, 39 fueron normales, 96 se clasificaron como glomerulopatía primaria, 26 como glomerulopatía secundaria y 5 como nefropatía túbulo-intersticial. Se pudo diferenciar el origen de la hematuria en 58 de estas orinas. Además, detectamos cadenas ligeras libres tipo kappa, confirmadas por inmunofijación, en una muestra de orina de un paciente con un proteinograma normal en suero. Conclusión: Con el algoritmo propuesto, la información obtenida de una muestra de orina aumenta mucho, permitiendo la detección y diferenciación de la proteinuria y aportando sugerencias para la evaluación clínica del paciente

Background and objective: When proteinuria appears, a differential diagnosis must determine its origin. The object of this work has been to evaluate the results after the laboratory implantation of an algorithm for the screening and diagnosis of proteinuria. Material and methods: From a total of 30,718 processed urines, a 30 mg/dl or higher protein concentration was obtained in 639, recommending a new sample to confirm and differenciate proteinuria. We received 207, to which total protein, creatinine, albumin and alpha-1-microglobulin were quantificated, together with pseudoperoxidase and leucocite esterase from dipstick. The results were introduced in an expert system (UPES and its application Protis), allowing differenciate hematuria, leucocituria and proteinuria and suggesting the assessment of other parameters, like IgG, alpha-2-macroglobulin, light chain kappa/lambda, when necessary. Results: From 207 urinalysis assayed for selective proteinuria, 39 were normal, 96 were classified as primary glomerulopathy, 26 as secondary glomerulopathy and 5 as tubulo-interstitial nephropathy. A differential diagnosis of hematuria was made in 58 of these urines. Besides, kappa light chains were detected in a sample from a patient with a normal serum protein graph, which were confirmed by inmune fixation. Conclusion: With the proposed algorithm, the information obtained from a urine sample increases substantially, allowing detection and differentiation of proteinuria and providing suggestions for the clinical evaluation of the patient

Sociedad Española de Angiología y Cirugía Vascular. Mapa asistencial 2005 / Spanish Society of Angiology and Vascular Surgery. Health care map 2005

Introducción. La especialidad de Angiología y Cirugía Vascular (ACV) se ve sometida a una gran presión asistencial, sin que habitualmente dispongamos de datos concretos de la situación en otras provincias o comunidades autónomas que puedan ayudarnos a la hora de establecer mínimos asistenciales aceptables o de fundamentar negociaciones con las administraciones públicas. Materiales y métodos. Para conocer esta realidad asistencial actual se ha elaborado un censo de hospitales con asistencia específica por especialistas en ACV. Los datos se recogieron por comunidades autónomas, y se registraron la población, el número de especialistas y la existencia y el número de unidades docentes. Para las comparaciones entre comunidades autónomas utilizamos como parámetros el número de especialistas y de camas por 100.000 habitantes como indicadores asistenciales de cara a la población, y el número de camas por especialista como reflejo de la presión asistencial individual. Resultados. El número total de especialistas es de 445. Hay 1.628 camas agrupadas en 91 unidades o servicios, 29 docentes. El número de especialistas por 100.000 habitantes es de 1,04. El número de camas por especialista es de 3,65, y el número de camas por 100.000 habitantes de 3,81. Se presentan los resultados por comunidades autónomas y por provincias, y su evolución desde el año 2000. Conclusiones. Han mejorado todos los parámetros nacionales desde el año 2000, aunque se aprecian todavía notables diferencias entre las áreas norte y sur del país, con algunas comunidades autónomas en situación crítica respecto a las posibilidades de asistencia en el marco de nuestra especialidad

Introduction. The rate of care that Angiology and Vascular Surgery (AVS), as a specialisation, is required to provide is high, and we often lack accurate data about the situation in other provinces or autonomous communities that can help us when it comes to establishing acceptable minimum health care services or laying down solid foundations for talks with the public administrations. Materials and methods. In order to gather a truer picture of the current health care situation we designed a census of hospitals that offer specific care by specialists in AVS. Data were collected by autonomous communities and the population, the number of specialists, and the existence and number of teaching units were recorded. For the comparisons between autonomous communities the parameters used were the number of specialists and beds per 100,000 inhabitants, as indicators of health care offered to the population, and the number of beds per specialist, as a measure of the individual rate of care. Results. The total number of specialists was 445. There were 1,628 beds in 91 units or services, with 29 teaching units. There were 1.04 specialists per 100,000 inhabitants, 3.65 beds per specialist, and 3.81 beds per 100,000 inhabitants. Results are presented by autonomous communities and by provinces, together with their progression since the year 2000. Conclusions. All the national parameters have improved since 2000, although striking differences can still be observed between the northern and the southern regions of the country; indeed, some autonomous communities find themselves in a critical situation as far as their capacity to provide health care within the context of our specialisation are concerned

Hemangiopericitoma maligno de antebrazo / Malign hemangiopericytoma of the forearm

Introducción. Los hemangiopericitomas son tumores vasculares muy poco frecuentes, con un comportamiento biológico impredecible y capacidad metastásica, cuya presentación habitual en las extremidades es en forma de masa de vasos neoformados que engloba o infiltra las estructuras vasculares. Caso clínico. Paciente de 23 años, sin antecedentes, que presenta una masa localizada en la cara anterior del antebrazo derecho con seis meses de crecimiento progresivo. El diagnóstico de imagen se realizó mediante ecografía Doppler, que mostró una masa encapsulada con vasos venosos y arteriales de baja resistencia; tomografía computarizada (TAC), que reveló una masa encapsulada con estructuras vasculares, y angiografía, que mostró una masa hipervascularizada con abundantes conexiones arteriovenosas y vasos neoformados. Se realizó un estudio de extensión general con gammagrafía ósea, TAC torácica y ecografía ab dominal normales. El tratamiento quirúrgico se practicó con intención curativa, y consistió en la resección completa de la masa tumoral, con márgenes de 2 cm y esqueletización de las estructuras vasculares tronculares y nerviosas, sin necesidad de procedimientos asociados. Posteriormente, el paciente recibió tratamiento radioterápico local hasta una dosis total de 66 Gy. El estudio anatomopatológico demostró una atipia celular y un índice mitótico elevado, y las técnicas de inmunohistoquimia e histoquímica argéntica permitieron demostrar el carácter pericítico de esta tumoración. A los 4 años, el paciente se encuentra asintomático y sin signos de recidiva local ni general (AU)

[Prediction of mortality and quality of life in polytraumatized patients: APACHE II versus APACHE III]. / Predicción de mortalidad y calidad de vida en politraumatizados: APACHE II frente a APACHE III.

OBJECTIVE: To evaluate the APACHE II and III prognostic assessment systems as predictors of mortality in polytraumatized patients and to compare each system's admission assessments to the patient's quality of life one month, six months and one year later. PATIENTS AND METHODS: A prospective study of 130 polytraumatized patients admitted to the critical care unit was carried out. A polytraumatized patient was defined as "presenting two or more traumatic lesions that were immediately or eventually life-threatening". We studied age, sex, type of trauma, mortality, mean APACHE II and APACHE III scores during the first three days in the critical care unit for patients who survived and those who died, estimating relative risk of mortality by APACHE II and APACHE III, and quality of life one month, six months and one year after admission using Karnofsky scores (KPS). RESULTS: Mean patient age was 46.47 +/- 20.19 years; 78% were men and 22% women. Overall mortality was 20%. The most frequent trauma was craniocerebral (70.76%), followed by injuries ot the chest (53.8%) and extremities (46.15%). Mean APACHE II and APACHE III scores during the first three days were 10.22 +/- 5.33 and 32.75 +/- 16.42, respectively. Mean APACHE II and III scores were significantly higher (p = 0.02) in patients who died than in survivors (14.33 +/- 5.43 and 9.7 +/- 5.2, respectively, for APACHE II; and 43.27 +/- 17.68 and 30.16 +/- 15.79, respectively, for APACHE III). For each point increase of APACHE II or III scores, relative risk of mortality increased 1.09% (p = 0.03) and 1.02% (p = 0.03), respectively. Patients with APACHE II scores over 12 were 3.53 times more likely to die (p = 0.02). Patients with APACHE III scores over 35 were 3.05 times more likely to die (p = 0.02). One month after admission, 6.4% of patients had a KPS of 100 (normal, as before trauma), 35.8% achieved this score six months after admission and 82% after one year (p = 0.01). Mean APACHE III upon admission was significantly lower (p = 0.045) in patients who achieved KPS 100. CONCLUSIONS: The APACHE II and APACHE III prognostic systems predict relative risk of death in polytraumatized patients. APACHE III, but not APACHE II, at admission is significantly related to quality of life one year later.

Serum soluble interleukin-2 receptor: a useful indicator of the clinical course in pulmonary tuberculosis.

SETTING: In tuberculosis both host protection and most pathogenic mechanisms depend on T lymphocytes. After activation by mycobacterial antigens, T cells both secrete interleukin-2 (IL-2) and express a high affinity receptor for this molecule (IL-2R) on their own surface. A soluble fraction of IL-2 receptor (sIL-2R), released from cell membrane, is detectable in serum and its concentration is known to be elevated in tuberculosis. OBJECTIVE: To ascertain the role of sIL-2R as an indicator of clinical evolution and response to antituberculosis treatment. DESIGN: A prospective study, in which we have measured serum sIL-2R in 52 patients (42 with active and 10 with inactive pulmonary tuberculosis) and in 36 healthy controls. In 20 patients, serum sIL-2R levels were measured serially throughout the treatment. Levels of sIL-2R were correlated to clinical and radiological parameters. RESULTS: Serum sIL-2R was significantly increased in patients with tuberculosis as compared to healthy subjects. Both the radiological findings and the clinical state of patients showed a good correlation with sIL-2R. All patients with normal values of sIL-2R 6 months after starting therapy had a favourable clinical evolution. CONCLUSION: Serum sIL-2R is a useful marker of the clinical state and evolution of patients with pulmonary tuberculosis. The detection of permanently high values beyond 3-6 months of treatment suggests that additional drugs or prolonged administration would be advisable in order to ensure full recovery.